Family members are a crucial part of a team approach to resident and patient care. This is especially so when a family member is serving in a health care proxy role. The intensely busy schedules of staff in long term and post-acute care facilities make it even more important to work collaboratively with family members.
A systems approach to family collaboration is one in which the organization as a whole—in this case the facility—and each of its components, such as admissions, nursing, activities, housekeeping, and therapy, take an interdependent approach to caregiving.
A facility that implements a systems approach to family collaboration examines the overall structures, patterns, and cycles in systems, rather than seeing only specific events in the system.
Focusing on the entire system can help facility leaders identify solutions that address as many problems as possible in the system.

The Family’s Viewpoint

Family members see only the care provided during the part of the day they are present. While this may seem obvious, caregivers working eight or more hours a day sometimes fail to appreciate that a family member’s impression may be based on the observations of only a few moments of care.
Viewing this from a systems perspective, what a person sees today at 1:00 p.m. is all he or she can know about the organization as a whole. This makes every moment important, but it also helps staff understand why it is sometimes hard for family members to believe their mother or father was cheerful all week, when what they see today does not support that claim.
A systems approach means that facility staff would first listen to families’ concerns and then provide them with information about what has taken place when they were not present. If the family members generally visit in the afternoon, invite them for an evening or a breakfast visit. Share specific anecdotes about times when they are not there. This can be very reassuring for families, especially when they feel their views have also been heard.
It is also helpful to understand that many family members are going through their own struggles. Adjusting to the move of a mother, father, husband, wife, child, or other loved one into long term care is a major life transition.
In meeting the challenge of appreciating a family member’s viewpoint, it is helpful to understand that the individual who visits the facility is usually someone who cares a great deal. Developing a connection with him or her will help to support the resident’s care.

Think Holistically

In addition to seeing only moments of the full range of care, it is important to understand that family members who visit do not usually think separately about the different care venues.
For example, nursing, activities, and rehabilitation are seen as part of the whole organization, and the actions of one staff member in one area will affect the family member’s perception of the entire facility.
Thinking of the whole organization as part and parcel of the solution is key to successful collaboration with family members.
In an example from one facility, a family member was sitting with her loved one at a meal when one of the assistants shouted at a resident and pulled her by the arm for trying to get something from the refrigerator.
How the other assistants or nurses respond to situations of this nature is critical. If no one addresses the action in any way, a family member witnessing this can only assume this is normal.
In another example, a family member saw that her loved one, sitting in a wheelchair, was locked in place, literally facing the corner of the room. In shock, she asked an assistant what was going on. The assistant immediately apologized, went to the nurse, and expressed concern that this had happened. Thus, the family member considered this to be an anomaly as opposed to a normal event.

Mission Should Reflect Culture

Does the organization have a stated vision or mission for responding to family members? Does everyone in the organization know about and share this vision? If not, developing a statement that clarifies expectations of staff toward family members is very helpful.
If there is a stated mission or vision, is this the actual culture of the organization? That is, while one organization may say they intend to welcome family members, the daily reality may be quite different. It is important for facility leaders to determine what the actual daily response is to family members.
In one facility, when family members walk into the living area, assistants look away and whisper with each other, ignoring the family member. In another, the assistants greet the families warmly and ask how they are doing.
All members of the facility impact the family members’ experience. For example, in the elevator, when the building supervisor or grounds crew say hello, it makes the family member feel positive about the facility.

Create Feedback Loops

Develop a specific protocol for staff and family to give suggestions and new ideas. Openness to new ideas allows for continual development. While most administrators tend to agree with these concepts, it takes real commitment to be willing to consider ideas that are different or unexpected.
Offer a variety of venues for staff, family, and residents to provide suggestions. At the same time, management should be given opportunities to discuss new ideas and get back to families, staff, and residents about those ideas.
It is also important to respond in a timely way. Calls from family members should be returned within 24 hours. If an employee doesn’t know the answer to a question, she should say so and give a time when she will respond.
Follow through on all promises. In one facility, the family member, having followed clothing directions carefully and asked repeatedly about their whereabouts, found her parent’s clothes strewn about the floor in an unmarked basement storage area. In another facility, all the resident’s clothes are carefully washed, organized, and placed back in their own personal locked closet.
Do not underestimate the importance of how personal effects are managed or treated. It can be perceived as an extension of the perception of the quality of care.


It is critically important to listen and to do so with the least amount of contention as is possible. Listen to the whole story, the whole concern, the whole issue, before venturing suggestions.
A family member may have helpful ideas. Family members cannot know or understand an organization’s expectations, rules, or way of doing things unless they are informed of them.
Are assistants encouraged to talk with family? Are a family’s questions encouraged and appreciated? Is it very different depending on whose shift it is? These are all cultural aspects that administrators should be able to answer. Attending to vision, goals, culture, follow-up, and commitments can make the entire difference in people’s lives as residents.
It can also make the difference for those family members who are involved.
A systems perspective suggests that supporting a culture that is inclusive, engaged, communicative, and upbeat will be most likely to support the best patient care and the best community for all involved.
Jeannette Gerzon, EdD, SPHR, based in Belmont, Mass., is an organization development consultant, trainer, and licensed psychologist. She can be reached at